Despite a recent call by one of the nation's top pediatrics organizations to increase children's vitamin D intake, doctors across North America continue to hold opposing viewpoints on the required amount of vitamin D needed by babies and children.
In the past decade, concern has been mounting among some doctors who believe breastfed babies must receive more vitamin D than their formula fed counterparts.
Though little vitamin D is generally found in breast milk, breastfeeding proponents fear focus on the amount of vitamin D in breast milk over its other health benefits could lead to decreased rates of breastfed infants. Infant formula contains added vitamin D.
Vitamin D is produced naturally by the body when children and adults
are exposed to sunlight. A lack of the vitamin D can lead to rickets, a
disease that causes softening and weakening of the bones.
Conflicting advice exists regarding what is considered a safe amount of sun exposure required to stimulate vitamin D production in children and infants. Some estimates say 15 minutes of sun exposure 3 times per week is enough, other disagree.
Complicating matters, parents of infants under the age of 6 months, are commonly told to keep their children out of direct sunlight to prevent the incidence of skin cancer later in life. Parents of older infants and children are told to regularly apply sunblock during outdoor play which decreases exposure to UV rays. In addition, more children are spending time indoors throughout the week.
Dr. Jack Newman, co-founder of Toronto's Newman Breastfeeding Clinic and Institute and author of the book, "The Ultimate Breastfeeding Book of Answers" said he believes the American Academy of Pediatrics recommendation on vitamin D sends the wrong message about breast milk's nutrition.
"I think they really don’t understand the implications of what they are doing," Dr. Jack Newman wrote in an email response to Green Parent Chicago regarding the new guidelines.
"They have made breastfeeding seem inadequate." he continued. "I have already heard that an article in at least one newspaper is saying that formula is superior to breastfeeding because of this. But that is so absurd; and yet, even if the other press articles do not say that, it’s there. And it’s a crying shame.
Babies can get all the vitamin D they need by going outside."
Newman calls for parents to increase time spent outdoors with children to help stimulate natural vitamin D production. Currently, efforts to increase children's outdoor activity exist separately from vitamin D education and research.
"A study from Ohio a few years ago showed that 60 minutes a week in summer with only a diaper on was enough." he said. "In winter, with only the face exposed 90 minutes a week is enough. If the mother is not vitamin D deficient herself, then the baby is born with a few months of vitamin D in the liver anyway.
So we should be encouraging mothers to go out with their babies. "
Dr. Jim Sears, one of the family of U.S. pediatricians behind the popular website, Ask Dr. Sears, recently answered a question online about whether vitamin supplements are necessary for an exclusively breastfed 4 month old.
"Unless their doctor determines otherwise, exclusively breastfed term
infants do not need extra vitamins. Human milk contains all of the
essential vitamins. As long as your infant is getting enough milk, he
or she is getting enough vitamins. Commercial formulas also contain all
the essential vitamins, providing your infant consumes the entire can
of formula each day."
Other doctors disagree with this saying vitamin D supplements are essential for breastfed babies.
The Children's Hospital in St. Louis hosts a web page devoted to vitamin D information for parents of nursing infants. Dr. James Keating, a pediatric gastroenterologist quoted on the page, directly points to breastfeeding as the cause of recent cases of rickets. Keating says, "breast milk can leave your baby lacking vitamin D, a vitamin essential to preventing deformities and other problems like rickets."
“When breastfeeding became more common a few years ago, we began seeing an epidemic of rickets that didn’t exist my first 20 years in practice—but it’s a preventable disease,” says Keating.
This August, The New York Times covered the vitamin D dilemma in an article entitled "Vitamin D Deficiency May Lurk in Babies", suggesting the threat of dangerous health effects of breastfeeding.
One mother, Stephanie
Remy-Marquez, of Hyde Park, Mass whose daughter's blood tests showed no detectable vitamin D and was diagnosed with rickets, says in the article, "I thought I was doing the best thing for her."
More research may be needed on the nursing mother's diet and whether or not supplementing the mother would benefit her child. Dr. Catherine M. Gordon, director of the bone health program at Children’s Hospital Boston and an author of several studies on vitamin D deficiency interviewed for the Times story, alludes to a problem that may lie in the nursing mother's diet:
"We’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up. They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk.”
